June 25, 2024

Understanding Workers’ Compensation in Florida

Workers’ compensation is a state-mandated insurance program that provides benefits to employees who suffer job-related injuries or illnesses. In Florida, most employers with four or more employees are required to carry workers’ compensation insurance. If you’re injured on the job, you may be entitled to benefits such as medical treatment, and temporary disability benefits, Workers’ compensation is a no-fault system, meaning that you don’t need to prove that your employer was negligent in order to receive benefits. Workers’ compensation is designed to protect you as an employee. Even if your employer was not at fault for your injury, you may still be entitled to benefits.

Reporting Your Injury

If you’ve been injured at work, the first step is to report the incident to your employer as soon as possible. You have 30 days from the date of the injury to report it to your employer. Failure to report your injury within this timeframe may result in your claim being denied.

When reporting your injury, be sure to provide the following

The date, time, and location of the incident
A description of how the injury occurred
A description of your injuries and any symptoms you’re experiencing
The names of any witnesses to the incident

Medical Treatment

After reporting your injury, your employer should provide you with a list of authorized medical providers. In Florida, you must seek treatment from an authorized provider for your medical expenses to be covered under workers’ compensation. Be sure to keep detailed records of your medical treatment.

After you’ve reported your work-related injury to your employer, your employer should notify their workers’ compensation insurance carrier. The insurance carrier will then take over the claims process. If your claim is denied or you disagree with any aspect of your benefits, you can try to resolve the dispute by contacting the insurance adjuster or seeking assistance from the Florida Employee Assistance Office. If the dispute cannot be resolved informally, your case may proceed to mediation, a pre-trial hearing, and a final hearing before a Judge of Compensation Claims.

If your doctor determines that you’re able to return to work, your employer may offer you light duty or modified work. If you refuse to accept this work, your benefits may be suspended or terminated. However, if your doctor has not released you to return to work, or if your employer does not offer you suitable work within your physical limitations, you may be entitled to continue receiving temporary disability benefits. If you’re unable to return to your previous job due to your injuries, you may be eligible for vocational rehabilitation services. These services can include job training, education, and job placement assistance to help you find suitable employment within your physical limitations.

June 3, 2024

Personal Injury Protection (PIP) in Florida

Understanding Personal Injury Protection (PIP) in Florida: What You Need to Know After a Motor Vehicle Crash

Personal Injury Protection

People who are involved in motor vehicle crashes within the State of Florida frequently ask us, what is Personal Injury Protection (PIP)? The literal answer is that Personal Injury Protection (PIP) is a type of insurance coverage that is contained within any motor vehicle (auto) insurance policy issued within the State of Florida and is one of only two types of insurance coverages required to be maintained on your motor vehicle under Florida law. The other required type of coverage is Property Damage Liability coverage. Everyone who owns a “motor vehicle” licensed with/by the State of Florida is required to obtain a motor vehicle insurance policy that contains $10,000 in PIP coverage for payment of medical and disability (lost wage) benefits or $5,000 in Death benefits and $10,000 in Property Damage Liability coverage in order to be able to lawfully drive on the public roads within the State of Florida. The State of Florida is one of many (but certainly not all) states that utilize, for motor vehicle insurance coverage purposes, what is generally referred to as a “No-Fault Law” and PIP insurance coverage is one of the primary components of this type of insurance approach.

The Florida Motor Vehicle No-Fault Law is codified within Florida Statutes Sections 627.730-627-7405 and its primary purpose is “to provide for medical, surgical, funeral, and disability insurance benefits without regard to fault, and to require motor vehicle insurance securing such benefits, for motor vehicles required to be registered in this state, and with respect to motor vehicle accidents, a limitation on the right to claim damages for pain, suffering, mental anguish, and inconvenience.”

What all of this means is that if you are a Florida resident and/or own a motor vehicle that is licensed in Florida, it is also insured under a motor vehicle insurance policy issued by a carrier (insurance company) operating under Florida law, if you are involved in a motor vehicle crash and you are injured and require treatment for those injuries or sustain lost wages related to the crash, regardless of whether you are at fault or the driver of any other vehicle involved in the accident is at fault, you will utilize the PIP coverage contained within your own insurance policy to pay for your accident-related medical treatment and lost wages.

Why Do I Have to Use My Own Insurance After a Crash That Wasn’t My Fault?

We have many clients who say to us that this does not make any sense. They say, “The crash was not my fault, why should I have to use my own car insurance to pay for my crash-related medical treatment? Why shouldn’t the at-fault driver’s car insurance company have to pay for my medical bills and lost wages?” The answer is that while we can understand why you think that it this law doesn’t seem fair, the Florida Legislature, way back in 1971, decided to change the law in Florida and create the Florida Motor Vehicle No-Fault Law. Since that time through the present, Florida’s No-Fault Law has existed in some form or another and it requires you to use the PIP coverage within your own motor vehicle insurance policy to pay for these types of crash-related expenses. The overall philosophy behind the No-Fault Law in general, and PIP insurance coverage specifically, is to make sure that your medical bills get promptly paid without requiring you to fight with the drivers of any other vehicles involved in your crash (and their insurance companies) about who was at fault for the crash. Those kinds of disputes and disagreements frequently arise after car crashes occur and if the No-Fault law was not in effect, then a lawsuit would then have to be filed to get your medical bills and lost wages paid. Lawsuits take time and money and require attorneys to be involved. The No-Fault law seeks to avoid that problem by mandating that your own car insurance and its PIP coverage, regardless of who is at fault for the crash, will be used to make sure that your accident-related medical bills and lost wages get paid. So, it’s a trade-off and unless and until the legislature changes the law, that’s the way payment of these expenses has to be handled.

The 14-Day Rule for PIP: Why Prompt Medical Attention After a Car Crash is Crucial in Florida

To qualify for PIP, you must report the injury to your policy and seek some type of crash-related medical attention within 14 days of the date of your motor vehicle crash in order to be eligible to receive any PIP coverage benefits contained within your auto insurance policy. If you do not receive any accident-related medical treatment within 14 days of the date of your motor vehicle crash, then under Florida law you have forfeited your right to have any of your accident-related medical bills paid for by the PIP coverage contained within your Florida motor vehicle insurance policy. Therefore, this is yet another very important reason for you to promptly seek medical treatment for any injuries or symptoms you have as a result of the motor vehicle crash. Our recommendation, if for no other reason than to avoid losing your entitlement to use insurance coverage that you have paid for, is that you go to a hospital, urgent care facility, or some type of physician or medical/chiropractic provider within 14 days of your crash and get checked out. Be sure to tell them that you were involved in a motor vehicle crash, give them the date and general location of the crash, and if you have pains or symptoms in certain areas of your body that have come on since the crash, tell them about those specific symptoms. If you are not feeling any specific pains, tell them that you just want to get examined so they can see if you have any problems that might have been caused by the crash. Many times, pain and symptoms caused by auto crashes or other types of accidents do not immediately cause pain or symptoms. It may be days or weeks later before you fell anything. But, due to this 14-day treatment requirement under Florida’s PIP law, in our opinion it’s better to be safe than sorry so this how we recommend you handle the situation. Feel free to call or email us, or contact us on the Web, if you’d like to discuss this further.

Why It Only Covers 80% of Medical Bills and How to Recover the Rest

You should be aware that the PIP coverage under your motor vehicle insurance policy does not pay for 100 percent of your accident-related medical bills. Rather, under Florida law, your PIP carrier ( your auto insurance company) is only required to pay 80 percent of the “reasonable amount” of any medical bills associated with any “reasonable and medically necessary medical treatment” that was necessitated by the motor vehicle crash after any PIP deductible contained in your policy is factored in. There is a Fee Schedule contained within the PIP statutes that is used to help determine what constitutes a “reasonable amount” of medical expense for a given type of treatment. Again, this is a topic that is subject to a fair amount of dispute and therefore a fair amount of litigation. Since the PIP carrier only pays 80% of your “reasonable bill amounts”, the remaining 20 percent is essentially a co-pay percentage that you are personally required to pay. The good news is that this co-pay percentage is an expense that can then be included within any claim that you file against the at-fault party, assuming that the crash itself was not your fault but instead was the fault of the driver of another motor vehicle involved in the crash. We can help you recover for these and other types of financial losses and damages that you sustain and also help you obtain compensation for any injuries you incur in the crash that are a result of someone else’s fault.

PIP Coverage Limits and Emergency Medical Conditions

The amount of PIP coverage required under Florida law is $10,000. While you are allowed to obtain PIP coverage with policy limits higher than $10,000, our experience is that few people do so. Therefore, for most people, once your PIP carrier has paid out its full $10,000 in PIP benefits, then generally speaking your PIP coverage will then be deemed “Exhausted” and you will thereafter have to find some other way to pay for any additional crash-related medical treatment, lost wages or loss of earning capacity that you incur. We invite you to contact our office to discuss whether we can be of assistance to you in this regard as depending on the facts of your crash ( i.e. Who was at fault), the types and amounts of insurance coverages that any other person or entity involved in the crash may have, as well as the other types of insurance coverages you may have under your own auto policy or potentially other types of insurance policies, we may well be able to help you obtain a financial recovery for these types of losses and for your crash-related injuries. Please be aware that in order to be eligible to receive the full $10,000 in PIP benefits, at some point in time after the crash occurs, you must have been deemed to have undergone an “Emergency Medical Condition (EMC)” as a result of the crash by a medical doctor, osteopath, dentist, physician’s assistant or nurse practitioner. If no such medical provider says that your injuries were of a magnitude that you sustained an EMC, then instead of being eligible for the full $10,000 in PIP benefits, that amount will be reduced to $2,500.

Vehicle Exclusions from PIP Coverage: Why Additional Insurance is Essential in Florida

Not every motor vehicle that travels on Florida roads is required to have PIP insurance coverage. For instance, the No-Fault Law contains several vehicle “exclusions”, such as a taxi cabs, school buses, any type of public transit bus, or motorcycles or motor scooters. Those vehicles are not required to have PIP coverage under their insurance policies. And, with respect to motorcycles or motor scooters, no insurance company will even write a policy on them that includes PIP coverage. However, with the exception of those specific types of vehicles and perhaps a few others, every other “motor vehicle” licensed within the State of Florida must have a motor vehicle insurance policy that includes $10,000.00 in PIP coverage and $10,000.00 in property damage liability coverage. This does Not mean that every vehicle driven on Florida roads actually contains these coverages, or any coverage for that matter. This is why we strongly suggest that you obtain Uninsured Motorist (UM), Bodily Injury and Collision and Comprehensive coverages within your own auto insurance policy. You do Not want to have to rely upon the other driver/vehicle being properly insured in order to be able to be fairly compensated for any financial damages and/or injuries you sustain in a motor vehicle crash caused by another’s negligence. However, that is a topic for another day, or at least for another article on our website.

April 25, 2024

Frequently Asked Questions About Workers’ Compensation Settlements

Do You Get a Settlement from Workers Compensation?

It depends. There is never a requirement for an injured worker to ever settle their case. However, this works both ways. The employer and the insurance carrier (“Employer/Carrier”) don’t ever have to settle the case either. Therefore, the only way a workers’ compensation case ever settles is if you and the Employer/Carrier are able to reach a settlement agreement that makes sense to both sides. No one can force the other side to settle a workers’ compensation case, not even the Judge of Compensation Claims (“JCC”). A judge is never able to force either side to settle, nor can a Judge set a value on settlement.

This is a difficult concept for most people going through a workers’ compensation case for the first time to understand. If a settlement agreement cannot be reached voluntarily between the parties, the case may never settle. And, the JCC does not have the power or authority to award a settlement of your case.

Settlement Options in Workers’ Compensation Cases

In any workers’ compensation case, you are ultimately faced with two options. The first option is to keep your case open and receive ongoing treatment for your injuries with a doctor authorized by the insurance company. If there are issues with your workers’ compensation benefits, you have the right to file claims with the court and have those specific issues addressed by the court. Again, the JCC would only have the power to rule on the specific claims at issue and cannot award a lump sum settlement.

The only other option other than keeping your case open is the possibility of settling your workers’ compensation case for a lump sum amount of money in exchange for closing out the case. As indicated above, settlement is always voluntary. Your right to authorized medical care and any right to future lost wages would end in exchange for a lump sum amount of money. And, if your claim is denied or disputed in some way by the Employer/Carrier, you would be agreeing to settle instead of having those issues resolved by the JCC. Again, the JCC has no power to settle your case but can resolve medical or lost wage disputes that may arise in your case.

Employment Considerations in Settlement Agreements

It is extremely important to note that most employers and their workers’ compensation insurance carriers will require you to leave your job as part of any settlement agreement. You are also often precluded from working for the employer in the future. These potential requirements could be a deal breaker for you if you do not want to leave your job or agree not to seek rehire. If you are no longer employed by the same employer where you were injured, this is obviously a non-issue. These issues require analysis above and beyond the injury.

Injured workers are also usually required to execute a General Release which would preclude you from suing the Employer/Carrier for any possible disputes outside of workers’ compensation such as overtime disputes or wrongful termination. While these potential issues would not be part of your workers’ compensation claim, they often are required as part of your workers’ compensation claim. These potential requirements can often be a deal breaker for an injured worker if they are not ready to leave their job or wish to pursue other claims outside of worker’s compensation. However, there are rare situations where you may not be required to leave your job as part of a settlement agreement. When negotiating a potential settlement agreement, it is important that you understand all of the terms and conditions of any offer to see if the settlement makes sense or not. Therefore, if you are possibly interested in the settlement but not willing to leave your employment, you will want your attorney to find out if this is a requirement to any settlement agreement.

Navigating Settlement Negotiations and Mediation

If the Employer/Carrier requires a separation of employment to settle and the injured worker is not interested in leaving their job, the claim will not settle unless circumstances change. In those situations, the injured worker should simply continue treating with the authorized doctor on a regular basis so the statute of limitations does not run. As long as the injured worker does not let the statute of limitations run, the claim will almost always have some settlement value once circumstances change. Obviously, there are many reasons why employment with a particular company may come to an end. Some people quit their jobs to work elsewhere. Some people plan to retire at some point. People get fired for reasons unrelated to their work accidents. Some people are physically unable to return to their job position at the time they were hurt. Others relocate to a new city or state. If/when circumstances change regarding your work status, you may want your attorney to contact the Employer/Carrier to begin negotiating a potential settlement on your behalf.

If you are interested in the possibility of overall settlement, you will want to have discussions with your attorney to begin the process. The Employer/Carrier rarely makes an offer without the injured worker starting the negotiations by providing an initial demand for settlement. Typically, your attorney will provide an initial demand for settlement on your behalf often starting higher than the case is probably worth. Obviously, the goal is to encourage the Employer/Carrier to offer as much money as possible understanding that they have no obligation to settle either.

Settlement negotiations can happen in a number of ways. Some cases settle through informal negotiations between the parties by way of phone calls, emails, or letters. However, in order for an agreement to be legally binding, it must be made in writing outlining the terms so there is no confusion later. Therefore, you want to be absolutely sure about your decision before instructing your attorney to accept an offer on your behalf since you will not be able to change your mind later.

In most situations, the Employer/Carrier may be interested in overall settlement, but this does not mean they will make a reasonable offer. While there are some cases that an Employer/Carrier may offer nothing to settle, as is their right, this is fairly unusual. In most situations, they are interested in discussing a settlement, but the key is your willingness to separate from the company, sign a General Release and reach a settlement figure that makes sense to both sides. Remember, there is no requirement that the Employer/Carrier has to settle any more than you do.

The value of every case varies depends on various factors but the same general rules apply. You and your attorney should discuss whether settlement makes sense at that particular point in time. For example, if you are required to leave your job as part of the agreement and you do not wish to do so, the settlement will not occur until circumstances change. Or, if the Employer/Carrier makes you an offer but you feel it is too low, you have every right to reject it and continue to keep your case open. Settlement negotiations can occur at any time if both sides are interested.

Settlement negotiations can also be conducted at a mediation. Mediation is an opportunity for both sides to meet and attempt to reach an agreement with help of a neutral and independent mediator. Some mediations are court-ordered while others are completely voluntary. If both sides are interested in settlement, the Employer/Carrier may want to set up a voluntary mediation to discuss overall settlement only. If there are medical or lost wage claims filed on your behalf, a court-ordered state mediation would need to occur before having your day in court on those particular issues. While the real purpose of a court-ordered mediation is to resolve any lost wage or medical issues, this is also an opportunity to discuss the possibility of the overall settlement. In most situations, the Employer/Carrier would prefer to discuss the overall settlement of the entire claim rather than resolve a lost wage or medical issue since it would result in a complete resolution of your case.

Settlement is always a possibility, but never a requirement

In sum, settlement is always a possibility, but never a requirement, for you or the Employer/Carrier. If settlement does not make sense to one side or the other or the parties simply cannot reach an agreement to the satisfaction of both sides, the case may never settle. If you are interested in the possibility of the overall settlement, you should immediately consult with a lawyer specializing in workers’ compensation to discuss it further.

March 28, 2024

Statute of Limitations

The statute of limitations is a law that restricts the timeframe in which a legal proceeding can be brought. Statute of limitations (SOL) are a nearly universal concept in all legal systems throughout the world. In the United States, we have different periods of limitations for federal cases and state cases. Additionally, the SOL will vary from state to state and from cause of action to cause of action.

Why Do We Have Statute of Limitations?

The reasons that we have limitations on when actions may be brought are fairly easy to understand. First, it is assumed that someone with a valid case would and should bring the case to court with reasonable diligence. The failure to bring a case when it should be brought has certain foreseeable consequences. If somebody waits too long to bring a case, the ability to defend it may be impaired because evidence is lost or memories have faded. Also it is assumed that people have the right or expectation to move on with their lives after a certain amount of time has expired.

Florida Chapter 95

Chapter 95 of Florida Statutes contains the Florida laws that limit various types of civil actions or claims. Those are generally cases involving people or corporations. The SOL involving many contract cases, certain labor laws, and foreclosures is five years. Negligence cases have to be filed within two years. Many other cases involving property disputes and intentional torts also have four year SOLs. Some civil causes of action in Florida have very short SOL’s, two years or less. Cases with extremely short SOL’s in Florida include professional malpractice, wrongful death claims, wage and overtime cases, slander cases and certain types of contract cases.

Workers’ Compensation & Statute of Limitations

Some areas of the law in Florida, such as workers’ compensation, have unique and complicated statutes of limitations. In Florida, you have two years from the date of accident to file a claim for benefits. This two year statute is tolled or extended after the initial two year period if you are receiving authorized medical treatment or receiving money benefits from the carrier. Every time you receive a benefit from the carrier, the SOL is extended for another year. For example, let’s say you were injured in an accident that occurred on May 5, 2017. If you timely report the accident to your Employer (within 30 days), then you have up until May 5, 2019 to pursue a claim or file a petition for benefits. That deadline is extended indefinitely if your treatment or receipt of money benefits from the insurance company is ongoing. If you see an authorized doctor for treatment on April 23, 2019, the SOL will be extended beyond the initial two year period until April 23, 2020.

Statute of Limitations Can Be Extended

Workers’ compensation also has other ways that the two year statute is extended. If the Employer misleads the employee or fails to inform that employee of their rights, the SOL can be extended. Other situations that can extend or revive the statute of limitations include situations where there are prosthetic implants in somebody’s body as a result of an accident or where a carrier authorizes medical care after the statute of limitations has already run. In this latter case, the carrier is said to have “revived” the claim, essentially bringing a dead claim back to life. SOL cases are very Fact specific, and cannot be answered in general terms.

February 29, 2024

Will Surgery Increase My Injury Settlement?

Understanding the Impact of Accidents

Accidents are not fun and cause a lifetime of significant physical pain and suffering as well as mental suffering. You can suffer a wide array of different types of injuries even from the smallest of accidents. You do not necessarily need to be involved in a huge accident resulting in a total loss of your vehicle for you to sustain significant personal injuries. Some people are more susceptible to injuries. Some injuries unfortunately result in having to undergo a surgical procedure to regain some type of pain relief to reestablish a good quality of life.

Navigating Insurance Coverage in Central Florida

In the State of Florida, bodily injury coverage is not a mandatory requirement on auto insurance policies. You can opt not to carry this coverage, but you do so at the risk of being sued personally if you cause an accident with injuries. Your assets can be taken, and your wages can be garnished. If you are hit by someone who does not carry bodily injury coverage, you can turn to your own insurance policy to see if you have any uninsured motorist coverage available to you. Having uninsured or underinsured motorist coverage on your own insurance policy is a wise decision since bodily injury coverage is not mandatory. Uninsured or underinsured motorist coverage compensates you, your resident relatives, or anyone traveling in your vehicle at the time of an accident for any injuries you suffer. When you are involved in an auto accident, one of the first things you should verify with the insurance company is how much bodily injury and uninsured or underinsured motorist coverage is available to you. The more coverage available, the more treatment you can receive for your injuries.

Assessing Injury Severity and Treatment Options

When you are involved in an accident and suffer any type of injury, you will most likely do some type of physical therapy to try to obtain some pain relief. The doctor will want to check to make sure there is no spinal damage or any tears or breaks to any ligaments or bones. They may refer you for MRIs which can determine if there are any internal injuries. If your MRI reveals any type of internal damage, you will likely be referred to a specialist for treatment.

Surgical Intervention and Considerations

If you suffer from any type of broken or fractured bones during your accident, these usually heal on their own after you have been placed in a cast or brace. If the bone does not heal or your doctor believes you need surgical intervention, you will probably be Surgery room with doctors and nurses scheduled for surgery. If you suffer from any spinal injuries such as disc bulges or herniations, your treating physician will likely refer you to an orthopedic surgeon or neurosurgeon to evaluate you. Physical therapy is generally ineffective for treating disc bulges or herniations. If you are referred to a specialist for your spinal injuries, chances are that the surgeon will opine that you should undergo either a series of epidural or branch block injections or possibly even surgery. If you opt to undergo injections, you will likely require continued injections for the rest of your life as this is only a temporary treatment solution. The only real permanent solution is usually surgical intervention.

Insurance Evaluation and Settlement Considerations

Just because you are referred for a surgical procedure does not mean the insurance company will consider that when evaluating your settlement claim. Insurance companies usually do not compensate you for a surgery you are recommended for, only for a surgery you have had. The adjuster will take all of your injuries into consideration, evaluate your past accident and medical history, and determine if the accident was the sole cause of your injuries. If you have been involved in numerous past accidents or have a pre-existing injury to the same body part you are claiming was injured in the accident, even if you have undergone a surgical procedure, the adjuster could claim it as an aggravation and offer you less money for your claim stating that the accident did not cause the injury. If this is the case, even if you have undergone surgery, if you have an Orlando personal injury attorney on your case, they will discuss with you the potential of having to file a lawsuit against the insurance company to fully compensate you for your injuries.

Assessing Settlement Value and Legal Recourse

If the insurance company finds no other pre-existing injuries, the chances of them making a settlement offer is likely. Surgery increases the value of your claim significantly in most cases as most surgeries are costly and require a period of recovery and physical therapy to get you back to as close to the health you were in before the accident as possible. Some surgeries, spinal fusions mainly, are invasive surgeries that can leave an unsightly scar. If you have an attorney on your claim, they will probably send pictures of your scars along with your medical bills and records when they are ready to negotiate a settlement amount for you, which will show the adjuster the physical damages you now have to live with for the rest of your life. A surgical claim is almost always worth more than a soft tissue claim which is basically just physical therapy treatment with not much permanent injury, due to the amount of the medical bills, the pain and suffering you have had to endure, and the unsightly scars you may be left with. The adjuster will consider all of these factors when making their offer and your attorney will discuss with you if they believe their offer is fair or if you should file a lawsuit against the insurance company.